1328 - Innovative Approach: Botox Injection to Rectus Abdominis Muscles in Neurofibromatosis Type 1- A Case Report

Case Diagnosis: A 28-year-old male with Neurofibromatosis Type 1 (NF1) and Spastic Quadriplegia.

Case Description: The patient received onabotulinum toxin type A (Botox) injections to the rectus abdominis muscles secondary to development of increased spasticity and dystonia in the trunk region leading to pain complaints. Prior to the initial procedure, the patient’s muscle tone was assessed and increased in bilateral lower extremities rated 3 on the Modified Ashworth Scale. 50 units of botulinum toxin were diluted 50 units/2cc of preservative free saline. 50 units were equally divided between the right and left trunk extremity with 5 sites each in the rectus abdominis. Ultrasound guidance was used to determine needle tip location for all trunk muscles. After 3 months a second trial was performed with increased dosage and even more efficacy. In addition, the right and left rectus femoris muscles were included. The patient tolerated both trial dosage procedures without complications. In both trials after a short observation period, the patient was discharged in stable condition.

Discussions: After 6 months consisting of 2 injection trials, the patient reports significant spasticity reduction, decreased abdominal pain, and increased range of motion of hip/thigh extension. Based on our literature review, this is the first reported case investigating the dosage of injections in rectus abdominis muscles for alleviating lower trunk muscle spasms in NF1 patients.

Conclusions: Further evidence-based practice is needed to elucidate the long-term effects and optimal dosing strategy guidelines for the rectus abdominis region.